*Purpose: Organ shortage is aggravated by an obesity epidemic. There is limited data on liver transplant (LT) outcomes from liver grafts originating from super obese donors. Herein, we study a unique cohort of recipients following LT from donors with a BMI >50.

*Methods: We retrospectively reviewed all adult LTs performed at our institution between April 2010-October 2019 with liver grafts from super obese donors (BMI>50).

*Results: In the study period, 18 patients underwent LT with a graft donated by a super obese donor. Median donor BMI was 55.8 (51.5-84.1). Recipients median follow up time was 1689 days (32-3367). Recipient’s median MELD at transplant was 22.5 (15-40). The post-transplant median ICU stay was of 1.5 days (0-22). The total length of stay was 7 days (3-29). Liver biopsy was performed in 14/18 grafts (77.8%). Macro-steatosis was seen on 9/14 (64.3%), of those, three had <5%, five had 5-30%, and one had 35%. Micro-steatosis was present on 9/14 liver grafts (64.3%), five had <5%, three had between 5-30%, and one had 90%. Seven (38.8%) patients experienced any type of complication within the first 30 days with 16.6% (3/18) presenting with a major complication (Dindo-Clavien >3b). Median MELD score at transplant for patients experiencing early complications was 23 (17-25). Acute cellular rejection was observed in 5/18 (27.7%) patients. Biliary complications occurred in 7 (38.8%) patients. Of those, 1 patient had a bile leak, and 6 had biliary stenosis treated with ERCP stent placement. Graft survival and patient survival rates at 1-year were 94.4% for both, and at 3-years were 86.7% and 92.9%, respectively.

*Conclusions: Liver transplantation with grafts from super obese donors can safely contribute to the expansion of the liver organ pool by achieving acceptable recipient outcomes.

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